Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization

Abstract

BackgroundIt has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This study's purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation.MethodsIn 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline.ResultsThere was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization.ConclusionsAcute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.

Left ventricular global longitudinal strain and mechanical dispersion predict response to multipoint pacing for cardiac resynchronization therapy

“…In accordance with these findings, MPP responders in our study also showed a significant acute improvement in LVEF and |GLPS| as well as a significant acute reduction in mechanical dispersion during MPP pacing configuration, whereas long‐term nonresponders did not. However, DeVecchi et al found that acute contractile recovery in CRT patients was not associated with 3 years prognosis. Bogaard et al also demonstrated that the acute improvement in LV dP/dt(max) was not correlated to clinical outcome (eg, 1‐year survival free from all‐cause mortality, heart transplantation, or LV assist device implantation).…”

“…In accordance with these findings, MPP responders in our study also showed a significant acute improvement in LVEF and |GLPS| as well as a significant acute reduction in mechanical dispersion during MPP pacing configuration, whereas long-term nonresponders did not. However, DeVecchi et al 18…”

Comparison of Speckle Tracking Echocardiography During Different Pacing Modalities for Cardiac Resynchronization Therapy Response Prediction

“…21,22 Patients' prognosis, however, may be insufficient in predicting CRT responsiveness, as documented by DeVecchi et al with respect to contractile recovery in patients following CRT. 23 In the current study, we investigated the possibility of using STE as a prediction tool for successful CRT implantation treatment. We were able to image patients immediately after the implantation, documenting cardiac function using all types of pacing prior to any remodelling achieved by the CRT.…”

Biventricular Pacing Going Along with Acute Hemodynamic Response in a Patient with Huge Anterior Wall Aneurysm – Importance of Pacing Viable Myocardium

“…Randomized trials on CRT did not investigate whether an acute improvement in contractility as measured by systolic blood pressure can predict long-term outcome. A non-randomized study by deVecchi et al that included 96 patients with systolic heart failure and CRT demonstrated that acute contractile improvement under biventricular versus RV pacing is not associated with 3 years prognosis [16].…”